A bladder cancer patient who has had the bladder removed will need to learn the basics of caring for their urinary diversion pouch.

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The diagnosis of bladder cancer brings with it some serious changes. You and your team of physicians will make treatment choices over the course of managing your bladder cancer that will affect your life thereafter. One of these choices may be surgical removal of the bladder, which is sometimes necessary to give you the best chance of a positive outcome.

The bladder is an organ that stores urine before it passes out of the body through a tube called the urethra. After removal of your bladder, your surgeon will create a new pathway for the urine to follow. One option is called a continent urinary diversion.

Bladder Cancer: How Continent Urinary Diversion Works

In this system, your surgeon will create a new reservoir or pouch from a piece of your intestine. This pouch will store the urine inside your body, just as your bladder did. The urine can then leave the body in one of two ways:

Continent cutaneous urinary diversion. The urine flows from the pouch through a stoma, an opening in the skin that is made in the abdomen.

Bladder substitute. The surgeon connects the pouch to your urethra so that you can empty it the way you used to empty your bladder, by urinating, or using a catheter through your urethra.

Bladder Cancer and Urinary Diversion: Emptying the Pouches

With continent cutaneous urinary diversion, you will need to drain the urine from the pouch. This is done by inserting a small tube, or catheter, through the stoma in your abdomen and into the reservoir. A little lubricant can be helpful as you carefully pass the clean catheter toward the reservoir. Sometimes a catheter with a curved tip can be more easily manipulated.

Once the catheter is in place, urine can then pass through it and drain into the toilet. With a little practice you will become adept at drainage. Over time your reservoir can stretch to hold more urine. You will probably need to empty it at least four times a day. Remember to wash your hands with soap and water before and after empting your urinary diversion reservoir.

Caring for Your Continent Urinary Diversion

The intestinal tissue, used to create the continent urinary reservoir, makes mucous, and if that mucous is allowed to collect it can block or limit the flow of urine through the catheter. To prevent this, you will need to “irrigate” or wash out your continent urinary diversion. While your doctor will provide specific instruction, in general this involves these steps:

Pass the catheter through the stoma into the reservoir and drain the urine.

Then fill a catheter-tipped syringe with sterile saline, a salt water solution, or water and inject it into the reservoir.

Drain out the fluid and whatever mucous was contained inside the reservoir.

Repeat the process of filling and emptying the reservoir until all mucous is cleared from the reservoir.

In the beginning you will need to irrigate your continent urinary diversion about once a day. However, after several months you will probably need to do it less often. Remember to wash your hands and your catheters with soap and water before and after draining or irrigating your reservoir. You can reuse the dry, clean catheters.

If you have a continent urinary diversion as part of your bladder cancer treatment, learning to use a catheter and how to drain and irrigate your reservoir may at first seem to be very bothersome and complicated. However, your doctors and specialty nurses are there to support you and help build your confidence. Before you know it, this entire process will become part of your everyday routine.

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